Julia Newton

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Julia L. Newton is a Clinical Professor of Ageing and Medicine at the University of Newcastle in the United Kingdom. She has published a number of ME/CFS studies focusing on autonomic nervous system dysfunction[1] and the role of inflammation in fatigue. She is a member of the UK CFS/ME Collaborative and is the Joint Medical Adviser of the charity Action for ME.

She is Director of the Newcastle Fatigue Research Group [2] and Associate Medical Director for Research for Newcastle upon Tyne Hospitals NHS Foundation Trust.

Dr. Newton serves on the editorial board of the journal, Fatigue: Biomedicine, Health & Behavior, published on behalf of the IACFS/ME.[3]

Notable studies[edit | edit source]

Talks and interviews[edit | edit source]

Talks for Dutch ME/CFS Society

2014, Playlist on YouTube containing:

Invest in ME International ME Conferences

  • 2008, Speaker at the 3rd Invest in ME International ME Conference on Autonomic Dysfunction: Identification of aetiologically distinct subject groups within ME/CFS[57] - (Video)
  • 2014, Speaker at the 9th Invest in ME International ME Conference [58]DVD available

Learn more[edit | edit source]

Online presence[edit | edit source]

References[edit | edit source]

  1. ↑ "Staff Profile - Institute of Cellular Medicine - Newcastle University". www.ncl.ac.uk. Retrieved August 10, 2018.
  2. ↑ "Fatigue Research - Faculty of Medical Sciences - Newcastle University". www.ncl.ac.uk. Retrieved August 10, 2018.
  3. ↑ "Fatigue: Biomedicine, Health & Behavior". www.tandfonline.com. Retrieved November 1, 2019.
  4. ↑ Hoad, A.; Spickett, G.; Elliott, J.; Newton, J. (2008). "Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome". QJM: monthly journal of the Association of Physicians. 101 (12): 961–965. doi:10.1093/qjmed/hcn123. ISSN 1460-2393. PMID 18805903.
  5. ↑ Newton, Julia L.; Sheth, Amish; Shin, Jane; Pairman, Jessie; Wilton, Katharine; Burt, Jennifer A.; Jones, David E. J. (April 2009). "Lower Ambulatory Blood Pressure in Chronic Fatigue Syndrome". Psychosomatic Medicine. 71 (3): 361–365. doi:10.1097/psy.0b013e31819ccd2a. ISSN 0033-3174.
  6. ↑ Hollingsworth, Kieren G.; Jones, David E. J.; Taylor, Roy; Blamire, Andrew M.; Newton, Julia L. (May 17, 2010). "Impaired cardiovascular response to standing in Chronic Fatigue Syndrome". European Journal of Clinical Investigation. 40 (7): 608–615. doi:10.1111/j.1365-2362.2010.02310.x. ISSN 0014-2972.
  7. ↑ Newton, JL; Mabillard, H; Scott, A; Hoad, A; Spickett, G (December 1, 2010). "The Newcastle NHS Chronic Fatigue Syndrome Service: not all fatigue is the same" (PDF). The Journal of the Royal College of Physicians of Edinburgh. 40 (4): 304–307. doi:10.4997/jrcpe.2010.404. ISSN 1478-2715.
  8. ↑ Jones, David E. J.; Hollingsworth, Kieren G.; Jakovljevic, Djordje G.; Fattakhova, Gulnar; Pairman, Jessie; Blamire, Andrew M.; Trenell, Michael I.; Newton, Julia L. (2011), "Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome: a case–control study", European Journal of Clinical Investigation, 42 (2), doi:10.1111/j.1365-2362.2011.02567.x
  9. ↑ Hollingsworth, KG; Hodgson, T; MacGowan, GA; Blamire, AM; Newton, JL (2012), "Impaired cardiac function in chronic fatigue syndrome measured using magnetic resonance cardiac tagging", Journal of Internal Medicine, 271: 264–270, doi:10.1111/j.1365-2796.2011.02429.x
  10. ↑ Frith, J.; Zalewski, P.; Klawe, J. J.; Pairman, J.; Bitner, A.; Tafil-Klawe, M.; Newton, J. L. (September 1, 2012). "Impaired blood pressure variability in chronic fatigue syndrome—a potential biomarker". QJM: An International Journal of Medicine. 105 (9): 831–838. doi:10.1093/qjmed/hcs085. ISSN 1460-2725.
  11. ↑ He, Jiabao; Hollingsworth, Kieren G.; Newton, Julia L.; Blamire, Andrew M. (2013), "Cerebral vascular control is associated with skeletal muscle pH in chronic fatigue syndrome patients both at rest and during dynamic stimulation", NeuroImage: Clinical, 2: 168-173, doi:10.1016/j.nicl.2012.12.006
  12. ↑ Jason, LA; Brown, A; Evans, M; Sunnquist, M; Newton, JL (2013), "Contrasting chronic fatigue syndrome versus myalgic encephalomyelitis/chronic fatigue syndrome", Fatigue: Biomedicine, Health & Behavior, 1 (3): 168-183, doi:10.1080/21641846.2013.774556
  13. ↑ Gotts, Z.M.; Ellis, J. G.; Newton, Julia L.; Deary, V. (2014), "The role of sleep in chronic fatigue syndrome: a narrative review", Fatigue: Biomedicine, Health & Behavior, 2 (3): 163-184, doi:10.1080/21641846.2014.935607
  14. ↑ Robinson, L. J., Durham, J., MacLachlan, L. L., & Newton, J. L. (2015). Autonomic function in chronic fatigue syndrome with and without painful temporomandibular disorder. Fatigue: Biomedicine, Health & Behavior, 3(4), 205-219.
  15. ↑ Jason, L.A.; Sunnquist, M.; Brown, A.; Newton, J.L.; Strand, E.B.; Vernon, S.D. (2015), "Chronic fatigue syndrome versus systemic exertion intolerance disease", Fatigue: Biomedicine, Health & Behavior, 3 (3): 127-141, doi:10.1080/21641846.2015.1051291
  16. ↑ Jason, Leonard A; Sunnquist, Madison; Brown, Abigail; Furst, Jacob; Cid, Marjoe; Farietta, Jillianna; Kot, Bobby; Bloomer, Craig; Nicholson, Laura; Williams, Yolonda; Jantke, Rachel; Newton, Julia L; Strand, Elin Bolle (2015), "Factor Analysis of the DePaul Symptom Questionnaire: Identifying Core Domains", Journal of Neurology and Neurobiology, 1 (4), doi:10.16966/2379-7150.114
  17. ↑ Brown, Audrey E.; Jones, David E.; Walker, Mark; Newton, Julia L. (2015), "Abnormalities of AMPK Activation and Glucose Uptake in Cultured Skeletal Muscle Cells from Individuals with Chronic Fatigue Syndrome", PLoS One, 10 (4), doi:10.1371/journal.pone.0122982
  18. ↑ Jason, LA; Kot, B; Sunnquist, M; Brown, A; Reed, J; Furst, J; Newton, JL; Strand, EB; Vernon, SD (2015), "Comparing and Contrasting Consensus versus Empirical Domains", Fatigue: biomedicine, health & behavior, 3 (2): 63-74, doi:10.1080/21641846.2015.1017344, PMID 26977374
  19. ↑ Rutherford, Gina; Manning, Philip; Newton, Julia L. (2016), "Understanding Muscle Dysfunction in Chronic Fatigue Syndrome", Journal of Aging Research, doi:10.1155/2016/2497348
  20. ↑ Gotts, Zoe; Deary, Vincent; Newton, Julia; Ellis, Jason (2016), "Treatment of insomnia reduces fatigue in chronic fatigue syndrome in those able to comply with the intervention", Fatigue: Biomedicine, Health & Behavior, 4 (4): 208-216, doi:10.1080/21641846.2016.1222699
  21. ↑ Pendergrast, Tricia; Brown, Abigail; Sunnquist, Madison; Jantke, Rachel L.; Newton, Julia L.; Strand, Elin Bolle; Jason, Leonard A. (2016), "Housebound versus nonhousebound patients with myalgic encephalomyelitis and chronic fatigue syndrome", Chronic Illness, doi:10.1177/1742395316644770
  22. ↑ Thorpe, Taylor; McManimen, Stephanie; Gleason, Kristen; Stoothoff, Jamie; Newton, Julia L.; Strand, Elin Bolle; Jason, Leonard A. (2016), "Assessing current functioning as a measure of significant reduction in activity level", Fatigue: Biomedicine, Health & Behavior, 4 (3): 175-188, doi:10.1080/21641846.2016.1206176
  23. ↑ Kidd, Elizabeth; Brown, Abigail; McManimen, Stephanie; Jason, Leonard A.; Newton, Julia L.; Strand, Elin B. (2016), "The Relationship between Age and Illness Duration in Chronic Fatigue Syndrome", Diagnostics, 6 (2): 16, doi:10.3390/diagnostics6020016
  24. ↑ Newton, Julia L.; Finkelmeyer, Andreas; Petrides, George; Frith, James; Hodgson, Tim; Maclachlan, Laura; MacGowan, Guy; Blamire, Andrew M. (2016), "Reduced cardiac volumes in chronic fatigue syndrome associate with plasma volume but not length of disease: a cohort study", Open Heart, 3 (1), doi:10.1136/openhrt-2015-000381
  25. ↑ Clark, James E.; Ng, W. Fai; Watson, Stuart; Newton, Julia L. (2016), "The aetiopathogenesis of fatigue: unpredictable, complex and persistent", British Medical Bulletin, 2016 (117): 139–148, doi:10.1093/bmb/ldv057
  26. ↑ Gotts, Z.M.; Deary, V.; Newton, Julia L.; Ellis, J. G. (2016), "A comparative polysomnography analysis of sleep in healthy controls and patients with chronic fatigue syndrome.", Fatigue: Biomedicine, Health & Behavior, 4 (2): 80-93, doi:10.1080/21641846.2016.1167470
  27. ↑ Jason, L. A.; McManimen, S.; Sunnquist, Madison; Brown, A.; Furst, J.; Newton, J. L.; Strand, E. B. (2016), "Case definitions integrating empiric and consensus perspectives", Fatigue: Biomedicine, Health & Behavior, 4 (1): 1-23, doi:10.1080/21641846.2015.1124520
  28. ↑ Jason, Leonard A; Sunnquist, Madison; Brown, Abigail; Evans, Meredyth; Newton, Julia L (2016), "Are Myalgic Encephalomyelitis and chronic fatigue syndrome different illnesses? A preliminary analysis", Journal of Health Psychology, 21 (1): 3-15, doi:10.1177/1359105313520335
  29. ↑ Jason, Leonard A; McManimen, Stephanie; Sunnquist, Madison; Newton, Julia L; Strand, Elin Bolle (2017), "Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia", ECronicon, 5 (1): 19-28, PMID 28713879
  30. ↑ Maclachlan, Laura; Watson, Stuart; Gallagher, Peter; Finkelmeyer, Andreas; Jason, Leonard A.; Sunnquist, Madison; Newton, Julia L. (2017), "Are current chronic fatigue syndrome criteria diagnosing different disease phenotypes?", PLOS One, doi:10.1371/journal.pone.0186885
  31. ↑ Tomas, Cara; Finkelmeyer, Andreas; Hodgson, Tim; MacLachlan, Laura; MacGowan, Guy A; Blamire, Andrew M; Newton, Julia L (2017), "Elevated brain natriuretic peptide levels in chronic fatigue syndrome associate with cardiac dysfunction: a case control study", Open Heart, doi:10.1136/openhrt-2017-000697
  32. ↑ Strassheim, Victoria; Lambson, Rebecca; Hackett, Katie L.; Newton, Julia L. (July 3, 2017). "What is known about severe and very severe chronic fatigue syndrome? A scoping review". Fatigue: Biomedicine, Health & Behavior. 5 (3): 167–183. doi:10.1080/21641846.2017.1333185. ISSN 2164-1846.
  33. ↑ Jason, LA; McManimen, S; Sunnquist, M; Newton, JL; Strand, EB (2017), "Clinical criteria versus a possible research case definition in chronic fatigue syndrome/myalgic encephalomyelitis", Fatigue: biomedicine, health & behavior, doi:10.1080/21641846.2017.1299077
  34. ↑ Davidson, Sean L.; Gotts, Zoe M.; Ellis, Jason G.; Newton, Julia L. (March 2017), "Two year follow-up of sleep diaries and polysomnography in chronic fatigue syndrome: a cohort study", Fatigue: Biomedicine, Health & Behavior, doi:10.1080/21641846.2017.1297280
  35. ↑ O’connor, Kelly; Sunnquist, Madison; Nicholson, Laura; Jason, Leonard A; Newton, Julia L; Strand, Elin B (December 12, 2017). "Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves". Chronic Illness: 174239531774647. doi:10.1177/1742395317746470. ISSN 1742-3953. PMID 29231037.
  36. ↑ Tomas, Cara; Brown, Audrey; Strassheim, Victoria; Elson, Joanna; Newton, Julia; Manning, Philip (October 24, 2017). "Cellular bioenergetics is impaired in patients with chronic fatigue syndrome". PLOS ONE. 12 (10): e0186802. doi:10.1371/journal.pone.0186802. ISSN 1932-6203. PMID 29065167.
  37. ↑ Schoeman, Elizna M.; Van Der Westhuizen, Francois H.; Erasmus, Elardus; van Dyk, Etresia; Knowles, Charlotte V. Y.; Al-Ali, Shereen; Ng, Wan-Fai; Taylor, Robert W.; Newton, Julia L. (March 16, 2017). "Clinically proven mtDNA mutations are not common in those with chronic fatigue syndrome". BMC Medical Genetics. 18 (1). doi:10.1186/s12881-017-0387-6. ISSN 1471-2350. PMID 28302057.
  38. ↑ Zalewski, Pawel; Finkelmeyer, Andreas; Frith, James; Maclachlan, Laura; Blamire, Andrew; Newton, Julia L. (2018). "Liver volume is lower and associates with resting and dynamic blood pressure variability in chronic fatigue syndrome". Fatigue: Biomedicine, Health & Behavior. 6 (3): 141-152. doi:10.1080/21641846.2018.1488525.
  39. ↑ Tomas, Cara; Newton, Julia L (2018), "Metabolic abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a mini-review", Biochemical Society Transactions, doi:10.1042/BST20170503, PMID 29666214
  40. ↑ Brown, Audrey E; Dibnah, Beth; Fisher, Emily; Newton, Julia L; Walker, Mark (2018), "Pharmacological activation of AMPK and glucose uptake in cultured human skeletal muscle cells from patients with ME/CFS", Bioscience Reports, doi:10.1042/BSR20180242
  41. ↑ Strassheim, Victoria; Welford, Jenny; Ballantine, Rob; Newton, Julia L. (December 2018). "Managing fatigue in postural tachycardia syndrome (PoTS): The Newcastle approach". Autonomic Neuroscience. 215: 56–61. doi:10.1016/j.autneu.2018.02.003.
  42. ↑ Clark, James E.; Davidson, Sean L.; Maclachlan, Laura; Newton, Julia L.; Watson, Stuart (2017), "Rethinking childhood adversity in chronic fatigue syndrome", Fatigue: Biomedicine, Health & Behavior, doi:10.1080/21641846.2018.1384095
  43. ↑ Finkelmeyer, Andreas; He, Jiabao; Maclachlan, Laura; Watson, Stuart; Gallagher, Peter; Newton, Julia L.; Blamire, Andrew M. (2018), "Grey and white matter differences in Chronic Fatigue Syndrome – A voxel-based morphometry study", NeuroImage: Clinical, 17: 24-30, doi:10.1016/j.nicl.2017.09.024, PMID 29021956
  44. ↑ Lynn, Megan; Maclachlan, Laura; Finkelmeyer, Andreas; Clark, James; Locke, James; Todryk, Stephen; Ng, Wan-Fai; Newton, Julia L.; Watson, Stuart (2018). "Reduction of glucocorticoid receptor function in Chronic Fatigue Syndrome". Mediators of Inflammation. doi:10.1155/2018/3972104.
  45. ↑ Strassheim, Victoria Jane; Sunnquist, Madison; Jason, Leonard A.; Newton, Julia L. (September 1, 2018). "Defining the prevalence and symptom burden of those with self-reported severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a two-phase community pilot study in the North East of England". BMJ Open. 8 (9): e020775. doi:10.1136/bmjopen-2017-020775. ISSN 2044-6055. PMID 30232103.
  46. ↑ Venter, Marianne; Tomas, Cara; Pienaar, Ilse S.; Strassheim, Victoria; Erasmus, Elardus; Ng, Wan-Fai; Howell, Neil; Newton, Julia L.; Van der Westhuizen, Francois H. (December 2019). "MtDNA population variation in Myalgic encephalomyelitis/Chronic fatigue syndrome in two populations: a study of mildly deleterious variants". Scientific Reports. 9 (1). doi:10.1038/s41598-019-39060-1. ISSN 2045-2322. PMID 30814539.
  47. ↑ Robinson, Lucy J.; Gallagher, Peter; Watson, Stuart; Pearce, Ruth; Finkelmeyer, Andreas; Maclachlan, Laura; Newton, Julia L. (February 5, 2019). "Impairments in cognitive performance in chronic fatigue syndrome are common, not related to co-morbid depression but do associate with autonomic dysfunction". PLOS ONE. 14 (2): e0210394. doi:10.1371/journal.pone.0210394. ISSN 1932-6203.
  48. ↑ Słomko, Joanna; Newton, Julia L; Kujawski, Sławomir; Tafil-Klawe, Małgorzata; Klawe, Jacek; Staines, Donald; Marshall-Gradisnik, Sonya; Zalewski, Pawel (March 2019). "Prevalence and characteristics of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in Poland: a cross-sectional study". BMJ Open. 9 (3): e023955. doi:10.1136/bmjopen-2018-023955. ISSN 2044-6055. PMID 30850404.
  49. ↑ Tomas, Cara; Brown, Audrey E.; Newton, Julia L.; Elson, Joanna L. (March 1, 2019). "Mitochondrial complex activity in permeabilised cells of chronic fatigue syndrome patients using two cell types". PeerJ. 7: e6500. doi:10.7717/peerj.6500. ISSN 2167-8359. PMID 30847260.
  50. ↑ Strassheim, Victoria; Deary, Vincent; Webster, Deborah A.; Douglas, Jane; Newton, Julia L.; Hackett, Katie L. (July 9, 2019). "Conceptualizing the benefits of a group exercise program developed for those with chronic fatigue: a mixed methods clinical evaluation". Disability and Rehabilitation: 1–11. doi:10.1080/09638288.2019.1636315. ISSN 0963-8288.
  51. ↑ Morten, Karl J.; Newton, Julia L.; Joanna L. Elson; Potter, Michelle; Lodge, Tiffany A.; Tomas, Cara (August 7, 2019). "Assessing cellular energy dysfunction in CFS/ME using a commercially available laboratory test". Scientific Reports. 9 (1): 1–9. doi:10.1038/s41598-019-47966-z. ISSN 2045-2322.
  52. ↑ Tomas, Cara; Elson, Joanna L.; Newton, Julia L.; Strassheim, Victoria; Walker, Mark (April 10, 2020). "The effect of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) severity on cellular bioenergetic function". PLoS ONE. 15 (4): e0231136. doi:10.1371/journal.pone.0231136.
  53. ↑ Tomas, Cara; Elson, Joanna L.; Newton, Julia L.; Walker, Mark (December 2020). "Substrate utilisation of cultured skeletal muscle cells in patients with CFS". Scientific Reports. 10 (1): 18232. doi:10.1038/s41598-020-75406-w. ISSN 2045-2322. PMC 7588462. PMID 33106563.
  54. ↑ Kujawski, Sławomir; Cossington, Jo; Słomko, Joanna; Dawes, Helen; Strong, James W.L.; Estevez-Lopez, Fernando; Murovska, Modra; Newton, Julia L.; Hodges, Lynette (October 26, 2020). "Prediction of Discontinuation of Structured Exercise Programme in Chronic Fatigue Syndrome Patients". Journal of Clinical Medicine. 9 (11): 3436. doi:10.3390/jcm9113436. ISSN 2077-0383. PMC 7693605. PMID 33114704.
  55. ↑ Kujawski, Sławomir; Cossington, Jo; Słomko, Joanna; Zawadka-Kunikowska, Monika; Tafil-Klawe, Małgorzata; Klawe, Jacek; Buszko, Katarzyna; Jakovljevic, Djordje; Kozakiewicz, Mariusz; Morten, Karl J.; Dawes, Helen; Strong, James W. L.; Murovska, Modra; Van Oosterwijck, Jessica; Estevez-Lopez, Fernando; Newton, Julia L.; Hodges, Lynette; Zalewski, Paweł; European Network on ME/CFS, (EUROMENE) (April 6, 2021). "Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients". Journal of Clinical Medicine. 10 (7): 1542. doi:10.3390/jcm10071542. ISSN 2077-0383.
  56. ↑ "Standing up for Fatigue - Professor Julia Newton and Professor Jason Ellis". Retrieved August 10, 2018.
  57. ↑ Research, Invest in ME. "Invest in ME Research - IIMEC3". Invest in ME Research. Retrieved August 10, 2018.
  58. ↑ Research, Invest in ME. "Invest in ME Research - IIMEC9 International ME Conference 2014". Invest in ME Research. Retrieved August 10, 2018.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

mitochondria Important parts of the biological cell, with each mitochondrion encased within a mitochondrial membrane. Mitochondria are best known for their role in energy production, earning them the nickname "the powerhouse of the cell". Mitochondria also participate in the detection of threats and the response to these threats. One of the responses to threats orchestrated by mitochondria is apoptosis, a cell suicide program used by cells when the threat can not be eliminated.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

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